Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-2280
2. Registrant Information.
Registrant Reference Number: PROSAR Case#:1-30238592
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Argentia Road, Plaza 5, Suite 101
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N2R7
3. Select the appropriate subform(s) for the incident.
Environment
4. Date registrant was first informed of the incident.
24-MAY-12
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
23-MAY-12
Product Description
7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.
Active(s)
PMRA Registration No. 28258
PMRA Submission No.
EPA Registration No.
Product Name: Home Defense Max Perimeter Indoor Insect Control with Pull N Spray A
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Small/Mammifère-De petite taille
2. Common name(s)
squirrel
3. Scientific name(s)
Unknown
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
1-30238592- The reporter, a home owner, indicates wildlife may have been exposed to an insecticide containing the active ingredient permethrin. The reporter stated she had applied the product to her lawn one day prior to her initial contact. She reported she had noted a squirrel on the application dragging its hind limbs and then dying just before the call. The pet owner was advised the animal s death was unlikely related to the use of the pesticide. Contact with the application area would be unlikely to elicit the signs or outcome seen. No further information is available.
8. a) Was the incident a result of (select all that apply)
Application
N/A
8. b) i) How many times has the product been applied this year?
Unknown
8. b) ii) What was the date of the last application?
23-MAY-12
9. Did it rain
9. a) During application?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here